Acute flaccid myelitis: cause, diagnosis, and management

AFM Working Grp, Olwen C. Murphy, Kevin Messacar, Leslie Benson, Riley Bove, Jessica L. Carpenter, Thomas Crawford, Janet Dean, Roberta DeBiasi, Jay Desai, Matthew J. Elrick, Raquel Farias-Moeller, Grace Y. Gombolay, Benjamin Greenberg, Matthew Harmelink, Sue Hong, Sarah E. Hopkins, Joyce Oleszek, Catherine Otten, Cristina L. SadowskyTeri L. Schreiner, Kiran T. Thakur, Keith Van Haren, Carolina M. Carballo, Pin Fee Chong, Amary Fall, Vykuntaraju K. Gowda, Jelte Helfferich, Ryutaro Kira, Ming Lim, Eduardo L. Lopez, Elizabeth M. Wells, E. Ann Yeh, Carlos A. Pardo*

*Corresponding author for this work

    Research output: Contribution to journalReview articleAcademicpeer-review

    17 Citations (Scopus)
    122 Downloads (Pure)

    Abstract

    Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of MM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for MM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.

    Original languageEnglish
    Pages (from-to)334-346
    Number of pages13
    JournalLANCET
    Volume397
    Issue number10271
    Early online date21-Dec-2020
    DOIs
    Publication statusPublished - 23-Jan-2021

    Keywords

    • GUILLAIN-BARRE-SYNDROME
    • ENTEROVIRUS D68 INFECTION
    • COLORADO CHILDREN
    • MOUSE MODEL
    • OUTBREAK
    • PARALYSIS
    • OUTCOMES
    • USA
    • ENCEPHALITIS
    • ANTIBODIES

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